Sharing decision-making with patients

Physicians often prescribe antibiotics to treat acute respiratory infections (ARI). However, this treatment is frequently ineffective, because many respiratory infections are viral in origin. In addition, overuse of antibiotics contributes to the development of antibiotic resistance. This situation continues because physicians assume that their patients want to be given antibiotics.

Only a quarter of the 181 patients who consulted a physician using the intervention reported a decision to take antibiotics.

In order to reduce inappropriate use of antibiotics, physicians should encourage their patients to get involved in decision-making. To do this, they need to inform their patients of the benefits and risks of taking or not taking antibiotics, while considering the patient's personal values and preferences. Unfortunately, few physicians engage their patients in this process.

France Légaré, professor at Université Laval and a Canada Research Chair holder, used studies carried out on shared decision-making to develop the professional training program DECISION+2. This program provides physicians with tools designed to support them in engaging in shared decision-making with patients presenting with signs of an ARI.

Physicians must first take a two-hour online tutorial that addresses the theoretical concepts and practical skills involved in the intervention. This is followed by an interactive workshop supervised by practitioners trained in shared decision-making. The workshop provides participants with the opportunity to apply the concepts from the tutorial. Both activities include videos, reflective exercises and decision support tools to help them to communicate the benefits and risks effectively to their patients. A reminder system is also put in place to ensure that the physicians have the tools they need to facilitate shared decision-making.

Following a pilot project, Decision+2 was tested in 2010 using groups of patients and physicians at nine family practice teaching units (FPTUs) in the Department of Family Medicine at Université Laval. All of the physicians at five of the FPTUs participated in the program by taking the tutorial and workshop and using the intervention during consultations with patients; the remaining four FPTUs formed a control group. The results of the trial are conclusive. Only a quarter of the 181 patients who consulted a physician using the intervention reported a decision to take antibiotics, compared with more than half of the control group of 178 patients.

The results of this project have had an immediate impact on university training in family medicine. The Faculty of Medicine at Université Laval has incorporated DECISION+2 into the curriculum for its residency program. Several training sessions have been offered to practicing physicians. France Légaré and her team are currently in discussions concerning the widespread implementation of the program, in both French and English settings.

If the program is followed systematically by family physicians across Québec, we can expect a decrease in the prescription of antibiotics for ARIs with no negative effect on patient health.